Contrast-induced Encephalopathy Following Embolization of Intracranial Aneurysms in Hemodialysis Patients

Abstract

Contrast-induced encephalopathy is a very rare complication associated with endovascular treatment of intracranial aneurysms. Patients with renal dysfunction may be prone to developing contrast medium neurotoxicity as a result of delayed elimination of the contrast medium in renal metabolism. This article focuses on our experience with contrast-induced encephalopathy in patients with end-stage renal disease requiring hemodialysis. The authors retrospectively reviewed five patients diagnosed with contrast-induced encephalopathy who underwent aneurysm coil embolization at their institution from January 2006 to December 2015. During the 10-year period, embolization was performed in 755 cases, among which contrast-induced encephalopathy occurred in five patients (0.66%). Three of the five patients were undergoing dialysis for chronic renal failure (one male and two female; mean age 66.7). Embolization for hemodialysis patients was performed in eight during the same period and the incidence of contrast-induced encephalopathy in hemodialysis patients is quite high in our series (3 of 8; 38%). Procedures were performed in one for recurrence of unruptured anterior-communicating artery aneurysm and in two for unruptured basilar-tip aneurysm. Mean approximately 220 ml of contrast media was used among three hemodialysis patients. All three patients showed an improvement or a control in symptoms soon after hemodialysis. Recovery of neurological symptoms was complete in two and almost normal in one within 1 week after intervention. Contrast-induced encephalopathy should be kept in mind as an expected complication of aneurysm embolization in hemodialysis patients. In hemodialysis patients with contrast-induced encephalopathy, performing hemodialysis is an effective treatment to improve symptoms early.

Contrast-enhanced encephalopathy and massive cerebral edema after endovascular coiling of cerebral aneurysm. A case report

“…26,27 The clinical presentation of CIEP often starts immediately after endovascular procedure with symptoms such as transient cortical blindness, depicted with unilateral or bilateral amaurosis fugax, normal pupillary light reflexes, and extraocular dysfunction. 3,11,[28][29][30] Also, patient present with headache, hemiparesis, aphasia, memory loss, as well as decrease in advanced mental functions like agraphia, loss of coordination, confusion, seizures, and coma. 3,5,31 Most often the patient is misdiagnosed as acute stroke after the procedure.…”

Contrast-Induced Encephalopathy after Coil Embolization: A Case Report and Review of Literature

“…Since 2010, there has been an increasing trend on the incidence of CIE (Table 1). To the best of our knowledge, there has been only one case that reports CIE after coil embolization using iodixanol contrast medium 9 . The clinical presentation of CIE can sometimes mimic acute stroke, but imaging findings present several characteristics of CIE.…”

Contrast-Induced Encephalopathy following Cerebral Angiography in a Hemodialysis Patient

“…e initial diagnosis is challenging mostly due to its close resemblance to acute stroke. One should have a high index of suspicion in every patient with new-onset neurological deficit who underwent angiographic procedure, especially in patients with hypertension and renal failure [9]. Imaging in the form of CT or MRI scanning is important at the early stage of CIE.…”